Multicentre Clinical Radiotherapy Audit in Rectal Cancer: Results of the IROCA Project

Overview

Journal Radiat Oncol

Publisher Biomed Central

Specialties Oncology
Radiology

Date 2020 Aug 29

PMID 32854730

Citations 2

Authors

Magdalena Fundowicz

Artur Aguiar

Carla Lopes de Castro

Maria Gloria Torras

Letizia Deantonio

Ewelina Konstanty

Marta Kruszyna-Mochalska

Miquel Macia

Eugeni Canals

Monica Caro

Carla Pisani

Dorota Zwierzchowska

Jaume Molero

Arantxa Eraso

Joana Lencart

Carles Munoz-Montplet

Luisa Carvalho

Marco Krengli

Julian Malicki

Ferran Guedea

Affiliations

Soon will be listed here.

Abstract

Purpose: To perform a clinical audit to assess adherence to standard clinical practice for the diagnosis, treatment, and follow-up of patients undergoing radiotherapy for rectal cancer treatment in four European countries.

Materials And Methods: Multi-institutional, retrospective cohort study of 221 patients treated for rectal cancer in 2015 at six European cancer centres. Clinical indicators applicable to general radiotherapy processes were evaluated. All data were obtained from electronic medical records.

Results: The audits were performed in the year 2017. We found substantial inter-centre variability in adherence to standard clinical practices: 1) presentation of cases at departmental clinical sessions (range, 0-100%) or multidisciplinary tumour board (50-95%); 2) pretreatment MRI (61.5-100%) and thoracoabdominal CT (15.0-100%). Large inter-centre differences were observed in the mean interval between biopsy and first visit to the radiotherapy department (range, 21.6-58.6 days) and between the first visit and start of treatment (15.1-38.8 days). Treatment interruptions ≥ 1 day occurred in 43.9% (2.5-90%) of cases overall. Treatment compensation was performed in 2.1% of cases. Treatment was completed in the prescribed time in 55.7% of cases.

Conclusions: This multi-institutional clinical audit revealed that most centres adhered to standard clinical practices for most of the radiotherapy processes-related variables assessed. However, the audit revealed marked inter-centre variability for certain quality indicators, particularly inconsistent record keeping. Multiple targets for improvement and/or harmonisation were identified, confirming the value of routine clinical audits to detect potential deviations from standard clinical practice.

Citing Articles

IROCA-TES: Improving Quality in Radiation Oncology through Clinical Audits - Training and Education for Standardization.

Malicki J, Castro C, Fundowicz M, Krengli M, Llacer-Moscardo C, Curcean S Rep Pract Oncol Radiother. 2023; 28(3):429-432.

PMID: 37795403 PMC: 10547405. DOI: 10.5603/RPOR.a2023.0035.

Results of the IROCA international clinical audit in prostate cancer radiotherapy at six comprehensive cancer centres.

Lopes de Castro C, Fundowicz M, Rosello A, Jove J, Deantonio L, Aguiar A Sci Rep. 2021; 11(1):12323.

PMID: 34112863 PMC: 8192927. DOI: 10.1038/s41598-021-91723-0.

References

Torras M, Canals E, Jurado-Bruggeman D, Marin-Borras S, Macia M, Jove J . Clinical Audit of the Radiotherapy Process in Rectal Cancer: Clinical Practice Guidelines and Quality Certification Do Not Avert Variability in Clinical Practice. Transl Oncol. 2018; 11(3):794-799. PMC: 6058082. DOI: 10.1016/j.tranon.2018.03.015. View

Jorgensen M, Young J, Solomon M . Optimal delivery of colorectal cancer follow-up care: improving patient outcomes. Patient Relat Outcome Meas. 2015; 6:127-38. PMC: 4445789. DOI: 10.2147/PROM.S49589. View

Scalliet P . Clinical radiotherapy audits in Belgium, 2011-2014. Cancer Radiother. 2015; 19(6-7):621-3. DOI: 10.1016/j.canrad.2015.05.006. View

Glimelius B, Myklebust T, Lundqvist K, Wibe A, Guren M . Two countries - Two treatment strategies for rectal cancer. Radiother Oncol. 2016; 121(3):357-363. DOI: 10.1016/j.radonc.2016.11.010. View

Taylor F, Quirke P, Heald R, Moran B, Blomqvist L, Swift I . Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence: 5-year follow-up results of the MERCURY study. J Clin Oncol. 2013; 32(1):34-43. DOI: 10.1200/JCO.2012.45.3258. View

Shortt K, Davidsson L, Hendry J, Dondi M, Andreo P . International perspectives on quality assurance and new techniques in radiation medicine: outcomes of an IAEA conference. Int J Radiat Oncol Biol Phys. 2008; 71(1 Suppl):S80-4. DOI: 10.1016/j.ijrobp.2007.07.2390. View

Fundowicz M, Macia M, Marin S, Bogusz-Czerniewicz M, Konstanty E, Modolel I . Preoperative radiotherapy for rectal cancer: a comparative study of quality control adherence at two cancer hospitals in Spain and Poland. Radiol Oncol. 2014; 48(2):210-8. PMC: 4078041. DOI: 10.2478/raon-2014-0008. View

Ohri N, Rapkin B, Guha C, Kalnicki S, Garg M . Radiation Therapy Noncompliance and Clinical Outcomes in an Urban Academic Cancer Center. Int J Radiat Oncol Biol Phys. 2016; 95(2):563-70. DOI: 10.1016/j.ijrobp.2016.01.043. View

Torras M, Fundowicz M, Aliste L, Asensio E, Boladeras A, Borras J . Improving radiation oncology through clinical audits: Introducing the IROCA project. Rep Pract Oncol Radiother. 2017; 22(5):408-414. PMC: 5554963. DOI: 10.1016/j.rpor.2017.07.004. View

10.

Cionini L, Gardani G, Gabriele P, Magri S, Morosini P, Rosi A . Quality indicators in radiotherapy. Radiother Oncol. 2007; 82(2):191-200. DOI: 10.1016/j.radonc.2006.12.009. View

11.

Charara R, Kreidieh F, Farhat R, Al-Feghali K, Khoury K, Haydar A . Practice and Impact of Multidisciplinary Tumor Boards on Patient Management: A Prospective Study. J Glob Oncol. 2017; 3(3):242-249. PMC: 5493220. DOI: 10.1200/JGO.2016.004960. View

12.

Steineck G, Schmidt H, Alevronta E, Sjoberg F, Bull C, Vordermark D . Toward Restored Bowel Health in Rectal Cancer Survivors. Semin Radiat Oncol. 2016; 26(3):236-50. DOI: 10.1016/j.semradonc.2016.03.002. View

13.

Keating N, Landrum M, Lamont E, Bozeman S, Shulman L, McNeil B . Tumor boards and the quality of cancer care. J Natl Cancer Inst. 2013; 105(2):113-21. PMC: 4481638. DOI: 10.1093/jnci/djs502. View

14.

Zerillo J, Schouwenburg M, van Bommel A, Stowell C, Lippa J, Bauer D . An International Collaborative Standardizing a Comprehensive Patient-Centered Outcomes Measurement Set for Colorectal Cancer. JAMA Oncol. 2017; 3(5):686-694. DOI: 10.1001/jamaoncol.2017.0417. View

15.

Smith B, Haffty B, Wilson L, Smith G, Patel A, Buchholz T . The future of radiation oncology in the United States from 2010 to 2020: will supply keep pace with demand?. J Clin Oncol. 2010; 28(35):5160-5. DOI: 10.1200/JCO.2010.31.2520. View

16.

Malicki J, Bly R, Bulot M, Godet J, Jahnen A, Krengli M . Patient safety in external beam radiotherapy - guidelines on risk assessment and analysis of adverse error-events and near misses: introducing the ACCIRAD project. Radiother Oncol. 2014; 112(2):194-8. DOI: 10.1016/j.radonc.2014.08.011. View

17.

Chen Z, King W, Pearcey R, Kerba M, Mackillop W . The relationship between waiting time for radiotherapy and clinical outcomes: a systematic review of the literature. Radiother Oncol. 2007; 87(1):3-16. DOI: 10.1016/j.radonc.2007.11.016. View

18.

Mackillop W, Bates J, OSullivan B, Withers H . The effect of delay in treatment on local control by radiotherapy. Int J Radiat Oncol Biol Phys. 1996; 34(1):243-50. DOI: 10.1016/0360-3016(95)02049-7. View

19.

Poston G, Tait D, OConnell S, Bennett A, Berendse S . Diagnosis and management of colorectal cancer: summary of NICE guidance. BMJ. 2011; 343:d6751. DOI: 10.1136/bmj.d6751. View

20.

Palta M, Willett C, Czito B . Short-course versus long-course chemoradiation in rectal cancer--time to change strategies?. Curr Treat Options Oncol. 2014; 15(3):421-8. DOI: 10.1007/s11864-014-0296-2. View